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MARYLAND STATE DEPARTMENT OF ASSESSMENTS & TAXATION
APPLICATION FOR EXEMPTION FOR SURVIVING SPOUSES OF A DISABLED VETERANS
Application to be filed with the Supervisor of Assessments at the appropriate office; a list of offices is attached.
This form seeks information for the purpose of an exemption for the surviving spouse of a disabled veteran on the indicated property.
Failure to provide this information will result in denial of your application. However, some of this information would be a “personal
record” as defined in General Provisions Article, §4-501. Consequently, you have the statutory right to inspect your file and to file a
written request to correct or amend any information you believe to be inaccurate or incomplete. Additionally, personal information
provided to the State Department of Assessments and Taxation is not generally available for public review. However, this information
is available to officers of the State, county, or municipality in their official capacity and to taxing officials of any State or the federal
government, as provided by statute.
Full Name of Titled Property Owner(s): ___________________________________________________________________________
Address of property: ________________________________________________________________________________________
County Account Number: ___________________________ (Baltimore City) Ward _____ Section _____ Block _____ Lot _____
Description of Property: _____________________________________________________________________________________
Date Property Acquired: __________ Former Address If purchased after Veterans Death: ________________________________
Veteran’s Name: _____________________________________ Date of Death: _______ State Death Occurred _____________
Has the applicant remarried? (Yes/No): _______ Was the veteran a Maryland resident at time of death? (Yes/No): ________
I declare under the penalties of perjury, pursuant to Section 1-201, Tax Property Article, of the Annotated Code of Maryland,
that this return (including any accompanying schedules and statements) has been examined by me and to the best of my
knowledge and belief is a true, correct, and complete return.
Signature of Surviving Spouse: _______________________________________________ Date: ____________________________
Printed Name: _______________________________________________ Email: _______________________________________
Mailing Address: _____________________________________________ Daytime Phone: _______________________________
Please check if transferring an exemption, provide previous address: ___________________________________
☐ Check to apply for a refund of any property tax paid for which you may be eligible under Tax Property Article 7-208.
• Attach a copy of the Veteran’s Honorable Discharge or a copy of DD-Form 214 as required by law. (Maryland Annotated
Code, Tax-Property Article, § 7-208)
• Attach a copy of the veteran’s most recent rating notification packetby the U.S. Department of Veterans Affairs (V.A.).
Document from the V.A. must indicate that the veteran’s final service connected disability rating was 100% permanent
and total or 100% permanently unemployable. This document must include the disability rating’s effective date and
date of the V.A. rating’s decision.
• Applicant must be a Maryland resident. Attach copy of a current Maryland driver’s license, voter’s registration, or
redacted previous year Maryland income taxes as proof of residency.
IF V.A. RATING DOCUMENT IS NOT AVAILABLE, THIS SECTION MUST BE COMPLETED BY THE V.A.
The United States Veterans Administration (V.A.) hereby certifies that the above named veteran, prior to or after his/her death, was
declared by the V.A. to have had a service-connected disability, which was not incurred through misconduct; that the said disability
was % disabling, permanent in character, and reasonably certain to have continued throughout the life of the said
veteran; had been receiving disability payments as allowed for reasons of % disability, or % unemployability.
The character of the disability is as follows: _____________________________________________________________________
_______________________________________________________________________________________________________
Effective Date of Final Disability Rating: ________ Date of V.A. Final Rating Decision: _____________
Adjudication/Service Officer Name: _________________________________________ Date _______________________
Mailing Address: __________________________________________________________________________________________
Daytime Phone __________________________________ Email: _____________________________________
THIS APPLICATION IS NOT OPEN FOR PUBLIC INSPECTION
FOR ASSESSMENT OFFICE USE ONLY
Office Comments: _______________________________________________________________________________________________________
Approved [ ] Disapproved [ ] Effective Date: _____________________
Supervisor’s Signature _______________________________________________________ Date: ________________________
SDATRP_EX4B Rev July 2024 http://dat.maryland.gov
